HSJ Weekly Catch Up: French figures, digital dilemmas and an almost empty hospital

Problems for the future

The coronavirus outbreak could be seen as a landmark moment for tech in the NHS, following a rapid increase in digital appointments in recent weeks.

However, the Royal College of GPs’ chair Martin Marshall has raised concerns digital does not necessarily benefit all patients.

Professor Marshall said digital appointments could be “storing up problems for the future” for the treatment of mental health patients.

He added that, while digital appointments are necessary to prevent the spread of coronavirus, they may make some mental health patients feel uneasy.

This could make it difficult for GPs to treat and diagnose patients with mental ill-health, according to Professor Marshall.

Meanwhile, national guidance which one leader called “prejudiced” against older people has been swiftly withdrawn by NHS England.

NHSE published a reference guide over the Easter weekend on patient management during the coronavirus pandemic, which said care home and community hospital residents “should not ordinarily be conveyed to hospital”.

The guide also said dementia patients who suffer falls or head injuries should not be taken to hospital if they are “functionally unchanged,” unless authorised by a “senior colleague”.

One senior NHS leader had concerns this raised the bar for hospital admission above what is recommended by the National Institute for Health and Care Excellence, and said the guide “[seemed] prejudiced against older people,” placing “obstacles between vulnerable older people and ED”.

NHSE had updated its guide — removing the instructions on hospital conveyance — by 14 April, just days after the original was published.

Lost in translation

If you’ve been listening to the government’s daily coronavirus briefings, you’d be forgiven for thinking the UK’s covid-related deaths in hospitals tracked behind those of France. 

However, despite the global death comparison charts being presented as for hospital deaths only, the French curve has included data on both hospital and community deaths.

HSJ took a closer look at the figures on Tuesday and discovered that, if only the hospital deaths for France were included, the French curve would join those of Germany and South Korea in being well behind the UK deaths count.

France’s public health website clearly differentiates between hospital and community deaths.

When asked about the discrepancy at Tuesday’s briefing, neither Yvonne Doyle, medical director of Public Health England, nor Stephen Powis, national medical director for NHSE, acknowledged the error or apologised. Professor Doyle added: “It can be very difficult to understand what you’re looking at.”

By Thursday’s briefing, the chart had been updated with two lines for the UK — one using hospital-only deaths, and one using deaths in all-settings, which lags by more than a week, but shows UK numbers above those in France and Italy.  

Meanwhile, private sector IT experts drafted in to help the NHS address the coronavirus pandemic were warned this week they would lose their jobs if they exploit their position “for personal or corporate gain”.

NHSX chief executive Matthew Gould issued the warning in an email to NHSX employees, urging staff to speak to a member of the senior team if they fear someone has exploited a conflict of interest.

Mr Gould went on to say that challenges faced when working with contractors need to be carefully managed, and all should declare any conflicts of interest, or risk losing their job.

Keeping count

While the NHS’ daily count of covid-19 hospital deaths may be showing tentative signs of positive news, the Office for National Statistics’ latest offering of figures for weekly registered deaths in England and Wales cast a darker shadow.

There were 16,387 deaths in the week leading up to 3 April — 6,082 more than would normally occur that week, according to a five year average. However, just 3,475 of the death certifications mentioned covid-19.

What happened to the extra 2,607? It is not known. It could be some deaths were caused by the virus but not recorded as such. Or it may be that people are not seeking healthcare when they need it, too worried to go to a hospital or GP for fear of coronavirus. Or it may be that the NHS’ focus on the pandemic has weakened other services. Most likely a mixture.

Speaking of mismatched numbers, there appears to be a prospect of London’s celebrated Nightingale temporary hospital remaining largely empty during the coronavirus outbreak.

HSJ understands the conference-centre-turned-hospital was caring for just 19 patients over the Easter weekend. It is kitted out for almost 4,000.

This is because the capital’s existing hospitals have managed to double their intensive care capacity over the last month, and have so far been able to deal with the surge of covid-19 patients.

Normally, the underutilisation of such a huge facility would provoke public outcry, but, in this case, it’s a sign of success. Better to have prepared for the worst, rather than being caught short of ICU beds. And, of course, there may yet be a much greater peak of critical care demand in the capital.